09 Permission Release Form

IMAGES OF YOUTH 2009 VIDEO FESTIVAL

PERMISSION/RELEASE FORM •

EACH STUDENT PRODUCER INVOLVED IN THE PRODUCTION OF THE VIDEO MUST COMPLETE AND SUBMIT A PERMISSION/RELEASE FORM

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If you are younger than 18 years old, please have your parents/guardians complete the permission/release information below

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If you are 18+yrs, please sign the waiver at the bottom of the page.

I grant permission for my son/daughter, ___________________________________________ (Please print student’s name) video to be shown on the Images of Youth 2009 Video Festival Website on June 8, 2009. I understand that if my son/daughter’s video is selected for the festival, it may also be distributed for educational purposes by Action for Media Education. By signing below, I acknowledge that I have the authority to submit this program and that all required approvals, clearances, licenses, etc., for the use of the program material contained in this entry have been secured. By submitting I agree that Action for Media Education shall be held harmless from any and all liability arising from the broadcast or distribution of this video. I understand that if I have any questions about any of the above information, I can call Jennifer Slack 206-935-4712, or email at: [email protected] __________________________________________ Parent/Guardian, please print your name

Phone#_______________________

_____________________________________________________________________________ Parent or Guardian Signature _____________________________________________________________________________ Student signature indicates agreement with all Festival guidelines

WAIVER OF PERMISSION I hereby decree that I am 18+ years of age and therefore considered an adult who is not required to submit a parent/guardian permission form to the Images of Youth Video Festival. My signature indicates agreement with the above statements and all Festival guidelines. ______________________________________ Student name print

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____________________________________ Student signature